Problems with saliva

Question 1

4 functions of saliva in the oral cavity?

Answer 1

• Acid buffering
• Mucosal lubrication- speech, swallowing
• Taste facilitation
• Antibacterial

Question 2

5 causes of dry mouth?

Answer 2

• Salivary gland disease
• Drugs
• Medical conditions and dehydration
• Radiotherapy and cancer treatments
• Anxiety and somatisation disorders

Question 3

Which gland is associated with acinar tissue loss ?

Answer 3

• Minor glands

Question 4

Which other glands are associated with acinar tissue loss by age other than minor glands?

Answer 4

• Parotid and submandibular

Question 5

What do we call drugs that cause dry mouth?

Answer 5

Anti-muscarinic cholinergic drugs

Question 6

An example of an antimuscarinic drug?

Answer 6

Amitriptyline

Question 7

3 other drugs that cause dry mouth apart from amitriptyline?

Answer 7

• Lithium
• SSRI , TCA
• Bendrofluazide (10% reduction)

Question 8

5 chronic medical conditions that induce dehydration?

Answer 8

• Diabetes
• Renal disease
• Stroke
• Addison’s
• Persisting vomiting

Question 9

4 acute medical problems cause dehydration?

Answer 9

• Acute oral mucosal diseases
• Burns
• Vesiculobullous diseases
• Haemorrhage

Question 10

What 5 diseases causes direct salivary problems?

Answer 10

• ectodermal dysplasia
• Sarcoidosis
• HIV disease
• Gland infiltration amyloid and haemachromatosis
• Cystic fibrosis

Question 11

What is Challacombe scale for oral dryness?

Answer 11

A scale to measure oral dryness into mild, moderate and severe determined by 10 components which can be assessed visually
1-3 mild
3-6 moderate
7-10 severe

Question 12

Chalacombe 1?

Answer 12

mirror sticks to buccal mucosa

Question 13

Chalacombe 2?

Answer 13

mirror sticks to tongue

Question 14

Chalacombe 3?

Answer 14

Frothy saliva

Question 15

Chalacombe 4?

Answer 15

no saliva pooling in floor of mouth

Question 16

Chalacombe 5?

Answer 16

mild depapillation on tongue

Question 17

Chalacombe 6?

Answer 17

Altered gingival architecture

Question 18

Chalacombe 7 ?

Answer 18

Glassy appearance mucosa - esp palate

Question 19

Chalacombe 8?

Answer 19

Fissured tongue

Question 20

Chalacombe 9 ?

Answer 20

Cervical caries

Question 21

Chalacombe 10?

Answer 21

Debris on palate or teeth

Question 22

5 blood tests to investigate salivary disease?

Answer 22

• FBC
• U&E
• LFT
• Glucose
• Anti - ro,la, ANA
• C3 and C4 complement

Question 23

4 imaging modalities to investigate salivary disease?

Answer 23

• Plain radiographs with reduced dose to look for stones
• Sialography with contrast to show ducts
• MR Sialography - IV contrast
• Ultrasound

Question 24

Which protein blood test would you carry out to investigate a salivary disease?

Answer 24

C-reactive protein

Question 25

What two ways can anxiety contribute to the feeling of dry mouth?

Answer 25

1. cephalic control of salivation - directly causes xerostomia 2. cephalic control of perception - small changes at synapses causing perception of dry mouth

Question 26

Give 5 examples of somatoform diseases?

Answer 26

* Oral dysaesthesia * TMD pain * Headache * Dyspesia * Irritable bowel syndrome

Question 27

What are somatoform diseases?

Answer 27

the development of symptoms although there is no presence of the disease process on examination, mostly caused by the patient perception

Question 28

What two things on an ultrasound would indicate a salivary issue?

Answer 28

* Leopard spots * Sialectasis

Question 29

2 blood tests to investigate dehydration?

Answer 29

U&E Glucose

Question 30

2 blood tests to investigate autoimmune disease causing hyposalivation? other than anti la , ro

Answer 30

ANA CRP

Question 31

When would you decide to do a sialography for a patient with hyposalivation?

Answer 31

when you suspect obstruction or ductal disease

Question 32

3 causes that cause increased salivary flow?

Answer 32

Dementia Stroke Drug causes

Question 33

2 causes that lead to perception of hypersalivation?

Answer 33

* swallowing failure - anxiety, stroke, MS * postural drooling - in babies , cerebral palsy

Question 34

3 drugs that may cause hypersalivation?

Answer 34

* Clozapine * Bromides * Ketamine

Question 35

3 management options for dealing with hypersalivation?

Answer 35

* Treat the cause - anxiety * Training on swallowing control * Surgery - gland removal or duct repositioning * Anti-muscarinic drugs